Key Interventions of Palliative Cancer Care (Ki-Pcc) - Patient Perceived Need and Remembered Delivery By Health-Care Professionals (Hcp): a Prospective, Longitudinal, Multicenter Study

Abstract

Aim: The integration of PC in oncology is challenging, particularly in resource-restricted and regulatory disperse settings with variable training of HCPs. To identify gaps and in a second step to improve care of advanced, incurable cancer patients ( pts), we collect a “reality map” of KI-PCCs and quality indicators (QI). Methods: Randomly selected pts (ECOG PS 1-3, PC needs [≥3 IPOS items ≥2]) from predefined populations (5 Romanian, 1 Swiss institution) are followed for 6 months or until death. Demographics (modified EAPC basic dataset), PC needs (symptoms [IPOS], quality of life [EQ5D], perceived need for KI-PCC), remembered delivery of KI-PCCs by HCPs, and QI are assessed monthly. KI-PCC encompass 1. illness/ prognosis understanding 2. symptom management, 3. decision making, 4. spirituality, 5. End-of-Life preparation, and 6. support network ( pts, families). QI include inappropriate anticancer care, symptom burden, repeated ER admissions, aggressive EOL-care, and quality of death and dying (country-adapted QODD). This analysis at first follow-up (FU) explores the difference of KI-PCC need and delivery, the final analysis will test if KI-PCCs correlate with QIs. Results: 291 pts were included (61.5 y, 52% female, mean ECOG 2 [28% 3], common cancer types [lung, GI, GU], 78% chemotherapy, 66% urban, 47% college educ., 75% married, 15% living alone), 197 completed ≥1 FU so far. At baseline and FU, respectively, 211/147 pts (73/75%) felt to have all information, nurses judged 81/69 (28/35%) had; 67/34 poorly informed pts (23/17%) got no intervention (KI-PCC #1). 274/164 pts had ≥1 symptom, 109/- (40/-%) got all, 42/42 (15/26%) no symptom addressed (#2). 127/53 pts had toxicities requiring new decisions (44/27%), 81/38 (28/ 19%) got involved (#3). 223/120 pts (77/61%) had spiritual needs, 96/- (33/-%) had HCPs addressing them (#4). 64/39 pts (22/20%) wanted to discuss ≥1 EOL-issue (progression, terminal suffering, time left, family prepared, place of death, finish business) with HCP, in 43/30 (15/15%) it happened (#5). 56/30 pts (19/15%) needed help at home, 77/11 (26/6%) needed ER, in 40/19 (14/10%) a care plan was made (#6). Conclusions: Our data suggest a substantial gap between perceived need for and delivered KI-PCCs, without rapid change after 1 month. Swiss-Romanian Partnership (SNF-IZERZO_142226/1). Disclosure: All authors have declared no conflicts of interest.